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Highlights from Wide-Ranging Interview with Atul Gawande, Head of the New ABJ (Amazon/Berkshire/JP Morgan Chase) Healthcare Endeavor, Provides Glimpse of Vision and What They Hope to Accomplish

(Note: In keeping with our 2 Minute Drill mantra, we’ve broken this into two parts. Today in Part 1 we’ll highlight Gawande’s view of the three big systemic problems with healthcare. Tomorrow in Part 2 we’ll summarize his vision for the ABJ-HCE.)

Last week Amazon/Berkshire/JP Morgan Chase announced the appointment of renowned author, surgeon, and researcher Atul Gawande to head up their ambitious new “Amazon/Berkshire/JP Morgan Chase healthcare endeavor” (still unnamed, we’ll refer to it as ABJ-HCE for now). In a long form interview at the Aspen Ideas Festival Gawande expounded on his view of the problem facing the U.S. healthcare system and his thoughts on what the ABJ-HCE can do to make the whole system work better.

Here are few of Gawande’s thoughts that struck me as I watched the interview:

  • While healthcare comprises 18% of the U.S. economy, 30% of those expenditures are of no benefit to the patient.
  • The three biggest sources of waste are:
    • Very high administrative costs. He said there are a lot of “middlemen” in the system some of which must be taken out of the system to simplify the equation.
    • Pricing (I think he’s referencing the price of healthcare services and the method of paying providers for the services)
    • Mis-utilization of treatment. This is identified as by far the biggest of the three buckets. He defined mis-utilization as the wrong care, delivered at the wrong time, and in the wrong way.
  • On the reality of our healthcare system:
    • It was built in the 1940’s and 1950’s when there were only a handful of treatments.
    • Then: A system where the clinician could be expected to do it all – administer the right medicine and treatment. Add in some staff and a place for the patient to recover otherwise leave the clinician alone to do it all.
    • Now: We’ve discovered in the last century that the number of illnesses we can have and the number of ways the human body can fail exceeds 70,000 (covering 13 organ systems).
    • And, in the last fifty years we’ve generated 4,000 new surgical procedures and 6,000 new drugs.
    • Yet, we’re still deploying all these new discoveries and capabilities on a 40’s and 50’s system where the clinician will take care of it.

Gwande points to a broken system. Healthcare is now so complex “that everybody involved feels it’s out of their control – payors, patients, and providers — with no real influence over the end results. “Obamacare is on life support” and “even though I’m going to work for a bunch of employers, employer-based care is broken”.

Tomorrow in Part 2, Gawande on what’s needed, what ABJ-HCE brings to the table, and achieving his goal for the endeavor:  “Scalable solutions for better healthcare delivery everywhere”.

Warren Buffett on the Amazon/Berkshire/Chase health venture — “Don’t Expect Any Miracles Out Of Us”

A month and change has now passed since the great splash of January’s big Amazon/Berkshire/Chase health venture announcement. It certainly was successful in disrupting the news cycle. The initially sky-high healthcare “Richter Scale” readings are returning to normal. And, it’s pretty safe to say that any substantive changes, major disruption, and any new normal that may be triggered by this venture on big healthcare (20% of the economy), other employers – big, small and in between, and everybody else are not on the immediate horizon.

Like the CVS/Aetna venture announced last December, real change is likely to be More Tortoise Than Hare.

A sampling of Warren Buffett’s comments in some of his recent interviews with Bloomberg, CNBC, and KHN may provide you with a little more insight and a glimpse of some of his expectations.

Here are a few sound bytes from recent Buffett interviews:

He said that the goal of the business is “better care, lower costs,”and, that it will take time.”

This is not easy. If it was easy, it would have been done.”

It would be very easy I think to go in and shave off 3 or 4 percent just by negotiating power. We’re looking for something much bigger than that.”

He spoke of health-care spending taking up an increasing proportion of the U.S. economy, and a indicated that the goal of the venture is to “at least” halt that ascendant trend.

Buffett also stated that he hopes “we could find a way where perhaps better care could be delivered even at somewhat lesser cost.”

To read more go to Bloomberg: Buffett-Dimon Health Venture To Go Beyond Just Squeezing The Middlemen 

In Acquiring Aetna, CVS Health is Aspiring to Become “the Trusted Front Door to Health Care”. What’s the Impact on Current Aetna Customers?

In a letter to the broker community Aetna CEO Mark Bertolini provided a glimpse of where the combined CVS/Aetna entity hopes to head once everything is completed. If approved, the blockbuster transaction is expected to close late in 2018.

Here’s what Bertolini had to say:

“CVS Health and Aetna are joining to become the trusted front door to health care. Nearly 70 percent of the U.S. population lives within three miles of a CVS Health retail store and nearly five million Americans visit CVS Health every day. We will use CVS Health’s 9,700 retail locations to establish entirely new community health hubs dedicated to improving consumer wellbeing and answering questions about health, prescription drugs and health care benefits.

Our company will deliver care by utilizing CVS Health’s network of 1,100 in-store clinics, which are significantly less expensive than traditional health care delivery settings. Further integration of our pharmacy operations will help offset some of the projected increases in prescription drug prices, resulting in cost savings for employers and consumers.”

How Does This Week’s Announcement Impact Our Employer Clients Currently on Aetna Plans? And, Should You Be Concerned?

If you have an Aetna plan in place now or are considering switching to an Aetna plan in 2018 there’s no cause for any immediate concern.

According to Bertolini the pending transaction would have no immediate effect on the Aetna products already in place or any Aetna products offered in the market in 2018.

Or, as the title of a recent Wall Street Journal article analyzing the effects of the acquisition proclaimed CVS-Aetna Is More Tortoise Than Hare.

DO ELECTION RESULTS SIGNAL END OF OBAMACARE?

Highly respected industry expert Bob Laszewski provides an ongoing review of health care policy activity and the health insurance marketplace. We have followed his takes on healthcare reform for some time and have always found them to insightful, balanced, realistic and mostly on target.  And, you can count on straight talk, no bull.  We were very interested in his reaction to last night’s election results.

Here’s some of what Laszewski had to say about Obamacare immediately on the heels of last night’s presidential election:

There is no doubt that Obamacare is dead……..

…….There are two routes they will consider:

  1. Immediate repeal and replace that can rebuild insurance reform under the Senate 51-vote budget rule. Following this route will mean that the pre-existing condition reforms, for example, would have to remain in any new law because they are not budget related and would have to stay. The individual mandate (the Supreme Court declared it a tax) could be done away with as well as all of the exchange subsidies and the Medicaid expansion because they are spending related. Just what this path would look like in detail will depend upon what Senate budget rules ultimately determine to be budget items and whether that would be enough to build a health law consistent with a Republican vision.
  2. Effectively repealing by using the Senate 51-vote budget rules to gut the financing of the law on a future date certain. That would be followed by the Republicans saying to the country and the Democrats that Obamacare would continue as is until that future date––Obamacare would continue to cover everyone in the exchanges and under Medicaid. But if Democrats didn’t cooperate in legislating a new health insurance law, they will argue, it will be on the head of the Democrats that people lost their coverage on the day funding ends. This course could have the effect of forcing the Congress to agree on a new bipartisan path for health insurance reform––or result in one incredible implosion of coverage if the Democrats didn’t cooperate.

Either way, Obamacare is over.”

No words minced, for sure.

You can read Bob’s entire article Obamacare: Dead Law Walking!  here.

http://healthpolicyandmarket.blogspot.com

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